Maternal knowledge of infant feeding guidelines and label reading behaviours in a population of new mothers in San Francisco, California

The objective of this study was to evaluate the relationship between maternal nutrition knowledge and maternal socio-demographics including participation in the Special Supplemental Women, Infants and Children's (WIC) Program. A cross-sectional study of new mothers at two San Francisco hospitals was conducted using some of the American Academy of Pediatrics' guidelines in a structured questionnaire to assess maternal nutritional knowledge. Maternal nutritional attitudes towards product nutrient labels were also assessed in a questionnaire format. Logistic regression models were used to evaluate the odds of having high maternal nutrition knowledge and of infrequently reading nutrition labels. In multivariate logistic regression models, higher maternal nutrition knowledge (defined as answering all four nutrition questions correctly) was associated with higher income levels defined as ≥$25 000/year, odds ratio (OR) 10.03 95% confidence interval (CI) (1.51–66.74), and in linear models, higher nutritional knowledge was associated with having more children ( P  < 0.01), a higher income ( P  = 0.01) and not being a WIC participant ( P  < 0.01). Mothers with higher incomes were also more likely to read product nutritional labels OR 4.24, 95% CI (1.24–14.51), compared with mothers with lower incomes as were mothers with higher education levels OR 3.32, 95% CI (1.28–8.63). In San Francisco, lower income mothers are at greatest risk for low maternal nutrition knowledge and not reading product nutritional labels. Higher household income was independently associated with increased maternal nutrition knowledge and likelihood of reading nutritional labels. More comprehensive interventions need to target low-income mothers including current WIC participants to help close the nutritional advantages gap conferred by income and education.     

Determinants of maternal low mid‐upper arm circumference and its association with child nutritional status among poor and very poor households in rural Bangladesh

Malnutrition among women is a long‐standing public health concern that has significant adverse consequences on the survival and healthy development of children. Maternal mid‐upper arm circumference (MUAC) could potentially represent a simpler alternative to traditional nutritional indicators. This study aimed to investigate the factors associated with low maternal MUAC (as an indicator of being underweight) and address the research question of whether maternal MUAC is significantly associated with children''s nutritional status among poor and very poor households in rural Bangladesh. Data on 5,069 households were extracted from the Suchana programme baseline survey, which was carried out in 80 randomly selected unions (the lowest administrative unit of Bangladesh) in Sylhet and Moulvibazar districts between November 2016 and February 2017. The outcome variables were three child nutritional status indicators: wasting, stunting and underweight. Mothers were classified as underweight if their MUAC was less than 23 cm. Separate multiple logistic regression analyses were used to determine the factors potentially associated with maternal underweight status and explore whether maternal underweight status is significantly associated with children''s nutritional status. The prevalence of maternal underweight status was 46.7%, and the prevalence of wasting, stunting and underweight among children under two were 10.5%, 44.4% and 31.9%, respectively. After controlling for various socio‐economic and demographic characteristics, maternal MUAC was significantly associated with children''s nutritional status in rural Bangladesh.     

Relation of childhood malnutrition to parental education and mothers’ nutrition related KAP

Severely malnourished children (26), weight for age 55.27±3.17, were identified in a colony of predominantly Muslim urban slum dwellers of low economic status. An equal number of normally nourished children matched for age, sex and per capita income were identified. A strong relation was found between nutritional status of the subjects and educational level of their mothers (P<0.025). Father's education was unrelated to childrens' nutritional status. A thirty seven point questionnaire was administered to the mothers to record their nutritional knowledge, attitudes and practices (KAP). Analysis revealed that better KAP in relation to 16 of these 37 questions was not associated with better nutritional status. Seven questions were found to have only a weak association. The remaining 14 questions were identified as important for a nutrition education programme. Comparison of nutritional KAP score based on these 14 questions in case of mothers of normal and severely malnourished children revealed a significantly higher score in the former. Questions related to growth monitoring and breast feeding were not found to be important. No significant association was found between mothers' KAP and educational level. It is concluded that (i) Maternal education and KAP are significantly and independently associated with childrens' nutritional status. (ii) The content areas of knowledge, attitudes and practices significantly associated with nutritional status pertain to nutritional requirements of children, nutritional value of foods, immunisation, hygiene, oral rehydration and diarrhea.     

Mother surrogate and nutritional status of preschool children

The study was conducted on 200 preschool children to find out the effect of mother surrogate on the nutritional status. The nutritional status of children was found to be affected by the time devoted by mother on child care activities, working status of mother and type of family independently and jointly. The children cared by mother had better nutritional status than those children who were cared by servants and any other family member in the absence of mother. It shows that no one can substitute the care provided by the mother.     

Effect of counseling on nutritional status during pregnancy

Objective To assess the nutritional status and dietary practices among underprivileged pregnant women, identify the lacune, outline implement and assess the effect of nutritional counseling on their dietary intake, anthropometric status and anemia status. Methods Hundred pregnant women belonging to low socio-economic status were interviewed. Based on lacune, nutrition education (NE) was given in the form of simple messages to 50 subjects (NE-group) over 10–16 weeks period, while the remaining 50 formed the comparison group (Non-NE group). Tools used were individual counseling, weekly home visits and group meetings. Anthropometric measurements taken were height and weight. Dietary data was collected using 24-hour recall and food frequency questionnaire. Hemoglobin estimation was done. Effect of intervention was assessed by monitoring changes in dietary practices, weight gain, and nutritional status of the subjects. Results Baseline findings- low mean maternal body weight (51.05±7.26 kg), 96.3% anemia prevalence and severely suboptimal dietary intakes. Post-NE results revealed a significant increase in quality and quantity of the diets consumed. Mean hemoglobin levels significantly increased (Post-NEvs Non-NE=9.65±0.97vs 7.85±1.58, p<0.001) and anemia prevalence reduced (Post-NEvs Non-NE=78.7%vs 96%) in post-NE group. Conclusion Individual counseling with weekly reinforcement can bring about improvement in nutritional status during pregnancy.     

Does birth spacing affect maternal or child nutritional status? A systematic literature review

This review addresses the question of whether a short birth interval is associated with adverse nutritional outcomes for the mother or the child. Indices of anthropometric status (maternal weight or body mass index; child growth) and micronutrient status (e.g. iron or vitamin A) were included as outcomes. A computerized search of all relevant papers published since 1966 was completed, and the 'snowball' method was used to identify additional relevant published or unpublished papers. In total, 57 papers were found to contain data regarding the relationship between birth spacing and nutritional outcomes (35 for child nutrition, 11 for maternal anthropometric status, and 11 for maternal anaemia or micronutrient status). Of these, 23 papers were excluded from further consideration because they did not include any multivariate analysis, leaving 34 papers that met the criteria for the review (22 for child nutrition, eight for maternal anthropometric status, and four for maternal anaemia or micronutrient status). The studies on child nutrition outcomes indicate that a longer birth interval is associated with a lower risk of malnutrition in some populations, but not all. In those countries in which the relationship was significant, the reduction in stunting associated with a previous birth interval >or=36 months ranged from approximately 10% to 50%. Some of this reduction may be due to residual confounding, i.e. to factors not included in the analysis (such as breastfeeding and maternal height). The studies on maternal anthropometric outcomes yielded mixed results. Because the nutritional burden on the mother between pregnancies depends on the extent of breastfeeding, the interpregnancy interval is not the best measure of whether the mother has had a chance to recover from the pregnancy, in terms of repleting her nutritional status. Therefore, some studies examined the 'recuperative interval' (duration of the non-pregnant, non-lactating interval) instead. Taken as a whole, the studies do not provide clear evidence of a link between interpregnancy or recuperative interval and maternal anthropometric status. This may be due, in part, to changes in the hormonal regulation of nutrient partitioning between the mother and the fetus when a mother is malnourished. Only four papers were identified that related to micronutrient status, three of which examined maternal anaemia. One study showed an increased risk for maternal anaemia when the interpregnancy interval was <6 months, but the analysis did not control for iron supplementation during pregnancy. The other two studies did not show a significant association between interpregnancy interval and maternal anaemia. One study of micronutrient status indicated no significant relationship between interpregnancy interval and maternal serum zinc, copper, magnesium, ferritin, folate or thyroid-stimulating hormone. Important methodological limitations were apparent in most of the studies. Thus, further research with more comprehensive control of potentially confounding variables is needed.     

Theory‐based nutrition education intervention through male involvement improves the dietary diversity practice and nutritional status of pregnant women in rural Illu Aba Bor Zone,Southwest Ethiopia: A quasi‐experimental study

Maternal undernutrition is a major public health problem that disproportionately affects women in low‐income countries. Despite attempts to address maternal nutritional needs, Ethiopia still has a high rate of undernutrition. Hence, this study aimed to evaluate the effect of theory‐based nutrition education through male engagement on dietary practice and the nutritional status of pregnant women. A pretest−posttest quasi‐experimental study was conducted among 403 pregnant women selected from 22 kebeles of Illu Aba Bor zone, Southwest Ethiopia from July to December 2019. A pre‐tested, structured interviewer‐administered questionnaire was used for data collection. A qualitative 24‐h dietary recall was used to assess dietary diversity, and the Mid‐Upper Arm Circumference was used to assess nutritional status. The intervention effect was evaluated using difference‐in‐difference, generalized estimating equation, and linear mixed‐effects models. The mean dietary diversity score differed significantly between the couple group, women‐alone and the control group (p < 0.001). According to the multivariable generalized estimating equations model, couples were 3.9 times; adjusted odds ratio (AOR) = 3.91, 95% CI: (2.57, 6.88) and women alone were 2.8 times; AOR = 2.86, 95% CI: (2.17, 3.88) more likely to consume a diverse diet than the control group. The nutritional status of the women in the couple group improved significantly by the end of the intervention (p < 0.001). This study showed that involving males in nutrition education intervention was effective in improving the dietary diversity practice and nutritional status of pregnant women. The findings imply the need for targeting couples in designing nutrition education interventions.     

Factors associated with adverse nutritional status of children in sub‐Saharan Africa: Evidence from the Demographic and Health Surveys from 31 countries

Undernutrition is linked to almost half of all deaths in under‐five children. In 2019, 144 million under‐five children suffered from stunting and 47 million suffered from wasting. This study examined the factors that influence adverse nutritional status of children in sub‐Saharan Africa. The study used data from the Demographic and Health Surveys (DHS) of 31 countries, which involved 189,195 children under age 5. Binary logistic regression was used to examine the relationships between the independent variables and adverse nutritional status of children. About 26% of the children in the 31 countries in sub‐Saharan Africa considered in this study are stunted, 6% are wasted and 21% are underweight. Close to 31% of children whose mothers have no education are stunted, 9% are wasted and 28% are underweight. Adverse nutritional status of children is significantly associated with maternal age, education, household wealth, residence, antenatal care attendance, mass media exposure, child''s sex and size of child at birth. This study has shown that adverse nutritional status of children is a major challenge in sub‐Saharan Africa. Efforts at improving nutritional status of children should include poverty alleviation initiatives at individual and household levels, increase in women''s educational level and improvement in living conditions in rural areas.     

Associations between women's autonomy and child nutritional status: a review of the literature

Around the world, many women continue to experience low levels of autonomy. Recent literature has reported that the health consequences of low maternal autonomy extend beyond mothers and translate into health consequences for their children, and may be an important causal factor in child malnutrition. This review summarises the current knowledge of the relationship between maternal autonomy and children's nutritional status (defined as any measure that reflects the nutritional state of the body, such as birthweight or anthropometric scores) and child‐feeding practices. The review also includes both discussion of the limitations found in the literature and directions for future research. A systematic review of the literature was conducted. Results of the studies included in the review strongly suggest that raising maternal autonomy is an important goal for improving children's nutritional status, yet gaps in the current knowledge exist, further confounded by issues with how autonomy is measured and limitations of cross‐cultural comparability. A thorough understanding of the consequences of restricting women's autonomy will inform programmes and policy worldwide, and speed progress towards both empowering women and alleviating the global burden of child malnutrition.     

Relationship between the nutritional status of breastfeeding Mayan mothers and their infants in Guatemala

A case–control study was conducted to determine the association between maternal height and infant length‐for‐age, and to evaluate how this association is modified by either maternal or infant nutritional status. We hypothesised that maternal excess caloric intake [measured as body mass index (BMI)] would increase the association, while infant nutrition (measured in main meals consumed in addition to breastfeeding) will diminish the effect. Mother and infant pairs in Chimaltenango, Guatemala, were measured for anthropometric values and nutritional status, and mothers were interviewed to elicit nutritional and socio‐economic information. Infant length was converted into z‐scores based on the World Health Organization's (WHO) standards. Odds ratios (ORs), associated 95% confidence intervals (CIs) and the relative excess risk due to interaction (RERI) were calculated. Cases were infants below 2 z‐scores of the WHO's length‐for‐age, while controls were infants within the ?2 to 2 z‐score range. Cases (n = 84) had an increased odds (OR: 3.00, 95% CI: 1.57–5.74) of being born to a stunted mother (below 145 cm) when compared with controls (n = 85). When adjusted for potential confounders, the OR decreased to 2.55 (95% CI: 1.30–5.02). Negative RERI values were produced for the joint exposure of maternal BMI ≥ 25 and maternal stuntedness (RERI: ?0.96), as well as for the joint exposure of maternal stuntedness and infant nutrition (RERI: ?2.27). Our results confirm that maternal stuntedness is a significant contributor to infant stuntedness; however, this association is modified negligibly by maternal nutritional status and significantly by infant nutritional status, each in a protective manner.     

Maternal nutrition in rural Kenya: health and socio-demographic determinants and its association with child nutrition

High levels of food insecurity and human immunodeficiency virus (HIV) infection place most breastfeeding mothers in Kenya at high risk of malnutrition. We examined the role of selected socio-economic, demographic and health factors as determinants of nutritional status among HIV-infected and HIV-uninfected mothers in rural Kenya and further examined the interrelationship between maternal nutritional and child nutritional status within this population. A cross-sectional design was used to collect data from non-pregnant mothers with children ages 4-24 months in Kisumu District, Kenya. Over 80% of the mothers were breastfeeding at the time of the study. Mean maternal body mass index (BMI) (21.60 ± 3.15) and percent body fat (22.29 ± 4.86) values were lower than among lactating mothers in other Sub-Sahara African countries. Maternal HIV status was not significantly associated with any of the maternal nutritional indicators assessed in the study. Breastfeeding, recent severe illness and having multiple children below 2 years of age were negatively associated with maternal nutritional status, while higher maternal age, socio-economic status and household food security were each positively associated with maternal nutritional status. Significant positive association was reported between maternal weight, height, BMI, mid-upper arm circumference (MUAC), body fat and fat-free mass estimates, and children's height-for-age, weight-for-age, weight-for-height and MUAC-for-age z-score. This analysis identifies determinants of maternal nutritional status in rural Kenya and highlights the importance of interventions that address malnutrition in both HIV-infected and HIV-uninfected mothers in rural Kenya. Significant association between maternal and child nutritional status stresses the importance of addressing maternal and young child nutritional status as interrelated factors.     

Maternal depressive symptoms, father's involvement, and the trajectories of child problem behaviors in a US national sample

OBJECTIVE: To examine the effect of maternal depressive symptoms on child problem behavior trajectories and how the father's positive involvement may modify this association. DESIGN: Secondary data analysis using data from the National Longitudinal Survey of Youth. SETTING: A nationally representative household sample of men and women from the National Longitudinal Survey of Youth. PARTICIPANTS: The study sample includes 6552 mother-child dyads interviewed biennially between January 1, 1992, and December 31, 2002; children were 0 to 10 years old at baseline. Intervention Past-week maternal depressive symptoms in 1992. MAIN OUTCOME MEASURES: Maternal self-reports of child internalizing and externalizing behaviors were assessed repeatedly using a modified Child Behavior Checklist. RESULTS: Linear growth curve models indicate that the adverse effects of maternal depressive symptoms on child problem behavior trajectories become negligible after controlling for the father's involvement and other covariates, including the child's age, sex, and race/ethnicity; the mother's educational level; maternal age at child birth; number of children; poverty status; urban residence; and father's residential status. Positive involvement by the father was inversely associated with child problem behavior trajectories. The effects of maternal depressive symptoms on child problem behaviors varied by the level of the father's positive involvement. CONCLUSION: When the father actively compensates for limitations in the depressed mother's functioning, the child's risk of problem behaviors may be reduced.     

Some determinants of nutritional status of one- to four-year-old children in low income urban areas in Tanzania.

Some socio-economic and demographic factors contributing to nutritional status (underweight and wasting) of children aged 1 to 4 years (n = 949) were studied in selected low income urban areas in Tanzania. Children were classified as either normal or malnourished and logistic regression was used in the analysis. Of the demographic variables studied, sex of the child was significant using both weight-for-age and weight-for-height indices. Males had better nutritional status than females. Mother's education level and age were significant risk factors using weight-for-age. Immunization status of the child and household density were also significant, but their effects became insignificant when morbidity and dietary variables were included in the analysis. Using weight-for-height the place of residence and number of children under 5 years in a household had significant effects on nutritional status through the latter was less significant when morbidity variables were incorporated. Children from big towns were significantly better off nutritionally than those from small towns. For dietary and morbidity variables frequency of feeding and diarrhoea were significant predictors of nutritional status (weight-for-age) while malaria was a significant predictor of weight-for-height.     

Maternal autonomy is inversely related to child stunting in Andhra Pradesh, India

Child stunting, an outcome of chronic undernutrition, contributes to poor quality of life, morbidity and mortality. In South Asia, the low status of women is thought to be one of the primary determinants of undernutrition across the lifespan. Low female status can result in compromised health outcomes for women, which in turn are related to lower infant birthweight and may affect the quality of infant care and nutrition. Maternal autonomy (defined as a woman's personal power in the household and her ability to influence and change her environment) is likely an important factor influencing child care and ultimately infant and child health outcomes. To examine the relationship between maternal autonomy and child stunting in Andhra Pradesh, India, we analysed data from National Family Health Survey (NFHS)-2. We used cross-sectional demographic, health and anthropometric information for mothers and their oldest child <36 months ( n  = 821) from NFHS-2. The main explanatory variables of autonomy are presented by four dimensions – decision making, permission to travel, attitude towards domestic violence and financial autonomy – constructed using seven binary variables. Logistic regression models were used to test associations between indicators of female autonomy and the risk of having a stunted child. Women with higher autonomy {indicated by access to money [odds ratio (OR) = 0.731; 95% confidence interval (CI) 0.546, 0.981] and freedom to choose to go to the market [OR = 0.593; 95% CI 0.376, 0.933]} were significantly less likely to have a stunted child, after controlling for household socio-economic status and mother's education. In this south Indian state, two dimensions of female autonomy have an independent effect on child growth, suggesting the need for interventions that increase women's financial and physical autonomy.     

Caregivers' nutritional knowledge and attitudes mediate seasonal shifts in children's diets

Smallholder farmers dependent on rain‐fed agriculture experience seasonal variations in food and nutrient availability occasioned by seasonality of production patterns. This results in periods of nutrient abundance in the plenty seasons followed closely by periods of nutrient inadequacies and malnutrition. This pattern contributes to a cycle of deteriorating health and nutrition status and deprives children of their ability to realize full developmental potential. This study investigates the role of caregiver's nutritional knowledge and attitudes in mediating effects of seasonality on children's diets. Repeated cross‐sectional surveys were conducted on 151 randomly selected households in the plenty and lean seasons to collect dietary data using two non‐consecutive quantitative 24‐hr recalls and caregiver's nutritional knowledge and attitudes assessed using interviewer administered questionnaire. Sixty‐five percent of the caregivers had attained a primary level education or less. There was a positive modest correlation between caregivers' nutritional knowledge and their attitudes (r = 0.3, P < 0.000, α = 0.01). Children's mean adequacy ratio was significantly higher in the plenty season than in the lean season (0.84 vs. 0.80, P < 0.000). A two‐block hierarchical regression to predict the seasonal changes in dietary quality of children using caregiver's nutritional knowledge and attitude scores while controlling for the effect of sociodemographics and mean adequacy ratio at first season (plenty) found that caregiver's nutritional knowledge (ß = ?0.007, SE = 0.003, P = 0.027, 95% CI [?0.013, ?0.001] ?² = 0.034) but not attitudes had significant contribution to the prediction. Maternal nutritional knowledge mediates seasonal variation in child nutrient intakes.     

Long term nutritional effects of ICDS

Nutritional status of 1243 children (636 boys and 607 girls) in the age group of 7–13 years was assessed in relation to utilisation of Integrated Child Development Services (ICDS) during their childhood. All the houses in every 10^th Anganwadi selected by systematic random sampling were surveyed in the ICDS project, Nand Nagri in East Delhi. Information regarding utilisation of ICDS facilities, sociodemographic details, general awareness etc. was collected by interview technique and anthropometric and clinical examination of every child was done and Anganwadi attendance score was calculated for each child. It was found that most of the children were nonbeneficiaries (59.1%). On univariate analysis Anganwadi attendance score, age, sex of the child and education status of the father showed statistically significant association (p<0.005) with malnutrition. On Multiple logistic regression analysis higher age (OR 1.4155 for grade 1 malnutrition and 1.6913 for grade 4 malnutrition) and being female (OR 1.5214 for Grade 4 malnutrition) remained significant risk factors for development of malnutrition for all grades. Anganwadi attendance score did not show any statistically significant association for decreasing the risk of getting malnourished for any grades of malnutrition in 7–13 years age group. There is special need to take special care for girls as well as to continue the special nutrition care even at an higher age. More in depth studies are needed so as to formulate effective nutritional policies for children.     

Seasonal trends and maternal characteristics as predictors of maternal undernutrition and low birthweight in Eastern Maharashtra,India

Few studies have assessed whether women and infants in rural and peri‐urban communities in South Asia experience seasonal fluctuations in nutritional status; however, a handful of studies have documented seasonal variability in risk factors for undernutrition including food availability, physical activity and infections. We used data from the Maternal and Newborn Health (MNH) registry, a population‐based pregnancy and birth registry in Eastern Maharashtra, India, to analyse seasonal trends in birthweight and maternal nutritional status—body mass index (BMI) and haemoglobin—in the first trimester of pregnancy. We plotted monthly and seasonal trends in birthweight, and maternal BMI and haemoglobin, and used multivariable regression models to identify seasonal and maternal characteristics that predicted each outcome. Between October 2014 and January 2018, MNH included 29,253 livebirths with recorded birthweight. BMI was assessed in 15,252 women less than 12 weeks of gestation and haemoglobin in 18,278 women less than 13 weeks of gestation. Maternal characteristics (age, education, parity and height) were significantly associated with nutritional status; however, there were minimal seasonal fluctuations in birthweight or maternal nutrition. There were significant secular trends in maternal haemoglobin; between 2014 and 2018, the prevalence of maternal anaemia decreased from 91% to 79% and moderate or severe anaemia from 53% to 37%. The prevalence of maternal underweight (45.3%) and overweight (9.8%) and low birthweight (19.1%) remained relatively constant over the study period. Our findings highlight that in some rural and peri‐urban areas in South Asia, tackling systemic drivers of malnutrition may be more effective than targeted interventions based on season.     

Does low birthweight influence the nutritional status of children at school age? A cohort study in northeast Brazil

Birthweight is recognized to be a determinant of a full term infant's early growth pattern; however, few studies have explored whether this effect is sustained into school age, especially in developing countries. We have used a cohort study from North East Brazil to investigate factors determining the anthropometric status of eight-year-old children born at full-term with low or appropriate weight. A cohort of 375 full-term infants was recruited at birth in six maternity hospitals between 1993 and 1994, in a poor region of the interior of the State of Pernambuco. At the age of 8 years, 86 born with low birthweight and 127 with appropriate birthweight were traced. Multivariable linear regression analyses were used to identify the net effect of socioeconomic conditions, maternal nutritional status and child factors on weight-for-age and height-for-age. An enter approach was used to estimate the contribution of different factors on child anthropometry. Birthweight had little influence on child nutritional status at school age. Maternal BMI and height together were the biggest contributors to variation in child weight-for-age (12.3%) and height-for-age (13.2%), followed by family socioeconomic conditions. Maternal height as a proxy of maternal constraint was the single factor that best explained the variation in both indices (6.2% for weight-for-age and 11.1% for height-for-age). Haemoglobin level measured at eight years made a small but significant contribution to variation in height-for-age (5.6%) and weight for age (1.4%). Maternal nutritional status, reflecting genetic inheritance and the poor socioeconomic conditions of this population, was the most important determinant of the nutritional status of children at school age, rather than birthweight.     

Anemia and nutritional status of pre-school children in Kerala

A study on the pattern of anemia and its relation to nutritional status and dietary habits was conducted among 3633 pre-school children of 108 selectedanganwadi centers in rural areas of Kerala State during the period 1996 to 1998. Children were invited with their parent or guardian. Capillary blood was collected from each child and hemoglobin was estimated by cyanomethemoglobin method. Weight and height of children were taken for assessing their nutritional status. The information regarding their age, sex, clinical condition and dietary habits was collected in a performa through an interview. Chi-square test was used to assess the relationship of anemia to sex, dietary habits, and nutritional status. For multivariate analysis logistic regression model was employed. The prevalence of anemia was 11.4%. The percentage of anemic children among male and female children was 10.25 and 12.55 respectively and statistical analysis showed that female childre were more susceptible to anemia. Normal nutritional status was seen among 46.7% of the children. When 187 (11.78%) of the mild undernourished children were anemic, the percentage anemic among the moderate undernourished children was 57, (16.37%). Moderate under nutrition and anemia showed a significant association. Anemia was reported among both vegetarians and non-vegetarians. Among 927 vegetarians, 86 (9.27%) were anemic and among 2,706 non-vegetarians, 328 (12.1%) were anemic. Dietary survey revealed that, consumption of iron sources, whether haem or non-haem, was below the recommended level. Undernutrition can be attributed as the major reason for nutritional anemia. Changes in eating behaviour could have potentially affected the iron bio-availability.     

Using structural equation modelling to understand the contributors to anaemia among young Burkinabe children

Anaemia is a persistent problem among young Burkinabe children, yet population‐specific information on its determinants is scant. We used baseline data from an evaluation of Helen Keller International's Enhanced Homestead Food Production Program (n=1210 children) to quantify household‐, mother‐, and child‐level factors associated with anaemia in Burkinabe children aged 6‐12 months. We used structural equation modelling to assess a theoretical model, which tested four categories of factors: (a) household food security and dietary diversity, (b) household sanitation and hygiene (latrine and poultry access and bednet ownership), (c) maternal factors (anaemia, stress, cleanliness, and health, hygiene and feeding knowledge and practices), and (d) child nutrition and health (iron deficiency (ID), retinol binding protein (RBP), malaria, and inflammation). The model also included household socio‐economic status, size, and polygamy; maternal age and education; and child age and sex. Results showed that ID, malaria, and inflammation were the primary direct determinants of anaemia, contributing 15%, 10%, and 10%, respectively. Maternal knowledge directly explained improved child feeding practices and household bednet ownership. Household dietary diversity directly explained 18% of child feeding practices. Additionally, RBP, child age and sex, and maternal anaemia directly predicted child haemoglobin. Our findings suggest that program effectiveness could be increased by addressing the multiple, context‐specific contributors of child anaemia. For young Burkinabe children, anaemia control programs that include interventions to reduce ID, malaria, and inflammation should be tested. Other potential intervention entry points suggested by our model include improving maternal knowledge of optimal health, hygiene, and nutrition practices and household dietary diversity.